RUC stands for the Relative Value Scale Update Committee, a group of 29 physicians from various medical specialties that meets three times a year to advise the Centers for Medicare and Medicaid Services on Medicare physician fee reimbursement and how certain procedures should be valued. Created by the American Medical Association in 1991, the committee has no official government standing, yet it yields great power.

“Real Life Practice Transformation,” a blog by TAFP President Melissa Gerdes, M.D., for AAFP’s Family Practice Management journal, gives physicians advice on implementing aspects of the medical home. Gerdes’ practice emerged as a star of the initial TransforMED National Demonstration Project, making her the perfect physician to share her experiences—good and bad—with the larger AAFP community.

The TransforMED model builds on the physician-patient relationship already cultivated in primary care, while adding new technology and approaches to help practices better serve the needs of patients and practices. The basics of the model focus on increasing patients’ access to care and information, becoming more efficient in practice management, enhancing practice-based services, expanding the use of health information technology, providing better care management, improving quality and safety, coordinating care in a more effective way, and supporting practice-based team care.

If it sounds like a lot, it is, and the NDP proved that practices need support from the entire staff and their patients to start implementing some of the recommendations. Reading Gerdes’ posts is a good first step to evaluating what the TransforMED recommendations can do for your practice.

Part of the mission of the TXFamilyDocs blog is to highlight the work of our members. I’d like to direct you to an insightful blog by TAFP member Richard Young, M.D., titled, “American Health Scare: How you are scared into buying health care you, your employer, and your country can’t afford.” On the blog and website, Young gives a family physician’s non-partisan perspective on the health care reform law and other big issues facing the specialty, challenging readers to consider the “appropriate role” of health care in our society and asserting that “the primary solution to expensive health care is that the relationship between doctors and patients must change.”

Texas lawmakers got their first chance to comment on the first draft of the House budget for 2012-2013 today, when Appropriations Chair Jim Pitts took questions on the floor. The draft budget is $31.1 billion slimmer than the state’s current budget, coming in at $156.5 billion in all funds. That means general revenue plus federal matching funds.

The capitol press corps was in fine form, tweeting and texting a constant stream of budget-related news, and filing stories at a fevered pace. Check out the Texas Tribune’s coverage for a healthy dose.

Several lawmakers were upset over the proposed closure of four community colleges, and massive cuts to public education got a lot of play as well. Lost amid the critiques and complaints was the proposed fate of a set of programs designed to strengthen primary care.

The biggest and toughest challenge legislators will face in the 82nd Texas Legislature will be balancing the budget. Comptroller Susan Combs announced that general revenue for the 2012-2013 biennium will likely be $72.2 billion, $14.8 billion less than the general revenue budget for the current biennium, and the shortfall in the current biennium would be $4.3 billion. She did not quantify the size shortfall expected in the next biennium, but the state would be about $27 billion short if lawmakers decided to continue current service levels in all programs.

Understanding the budget means looking at the two largest spending areas, articles II and III, otherwise known as education and health and human services, respectively. In his acceptance speech as president pro tempore of the Texas Senate, Sen. Steve Ogden, R-Bryan, told those in attendance to that it is “impossible to balance the budget” without making cuts to Medicaid and education.

At more than 1,000 words, the excerpt of the speech is lengthy, but it’s a must-read if you want to understand the next 140 days of the session.

As envisioned in the health reform law, the latest evolution of health delivery system reform involves consolidating the fragmented system of health care providers into efficient groups that take responsibility for a population of patients. Called accountable care organizations, this model boils down to three concepts: providing coordinated care by using all members of the health care team, measuring performance against evidence-based benchmarks, and reforming a payment system that currently rewards quantity over quality and reactive medicine over preventive medicine. The hope is that coordination, performance measurement, and payment reform will allow physicians to improve the quality of care for patients and reduce the cost.

Coordinating care to reduce cost isn’t a new concept. Some liken it to health maintenance organizations of the ’80s and ’90s, others to the patient-centered medical home. There is plenty of literature on both, and we won’t delve into them here.

If you’re looking for guidance on ACOs, one of the most useful sources is the five-year CMS pilot project that began in April 2005 and concluded in March 2010. (When lawmakers were crafting the health reform law, they had access to years 1 and 2. Now we also have 3 and 4, and are waiting for 5.)

Welcome to the next experiment in TAFP member interaction, the Texas Family Docs blog. In a post-health-reform era of rapid changes to the practice of medicine, your Academy hopes to use this space to delve into the topics most important to the family physicians of Texas.

This means explaining measures of health reform as they are implemented and tweaked, but also providing an insider’s look into Texas health policy, sharing practice management tips for all settings, highlighting tools and resources to improve your practice experience, sharing media links from the most influential medical journals, and more.

This is where you come in. The entire project began because you asked us to bridge these tough topics in a highly active forum. We want this to be a space where members contribute to the discussion. Comment on our posts or ask us how to submit your own. Share the most pressing issues facing your practice, a story from your medical training, or a “best practice” pearl that has helped you along the way. The possibilities are endless.

Recent Posts

By Jonathan Nelson

In yet another week of important committee meetings at the State Capitol, two family physicians provided testimony on some of TAFP’s top legislative priorities for the 86th Texas Legislature. On Monday, February 11, the House Appropriations Subcommittee on Article II convened to hear testimony from agencies and the public. Article II of the state budget contains funding for all agencies and programs that fall under Texas Health and Human Services, including Medicaid, CHIP, Healthy Texas Women, the Family Planning Program, services for the aging and those with disabilities, and much more.

TMA President and former TAFP President Doug Curran, MD, of Athens, told the committee that while Texas is indeed booming with a strong economy and lots of opportunity, many of the state’s health care statistics rank well below the national average.

By Jonathan Nelson

The Texas Legislature approached full stride this week as some of its most powerful committees began hearing testimony from state agencies and the public. The Senate Finance Committee took up Article II of the state budget, which contains funding for all agencies and programs that fall under Texas Health and Human Services. That includes Medicaid, CHIP, Healthy Texas Women, the Family Planning Program, services for the aging and those with disabilities, and much more. At roughly $80 billion for the biennium, Article II accounts for more than a third of total state expenditures.

Antonio Falcon, MD, of Rio Grande City, was the first TAFP member to address the committee on Wednesday morning, February 6, advocating for one of organized medicine’s top legislative priorities, the allocation of funding to ensure competitive and appropriate Medicaid payments. Those payment rates have not been increased in a meaningful or enduring manner in nearly two decades. Yet physician practice costs have increased by about 3 percent each year.

By Jonathan Nelson

We’re well into the third week of the Texas Legislature and now that the opening ceremonies are out of the way, lawmakers are beginning to get down to business. Both the House and the Senate have released their proposed budgets for the coming biennium, and both have announced committee assignments. Now the real work begins.

This session TAFP aims to fight for the restoration of funding for our family medicine residency programs to help address the increasing shortage of primary care physicians practicing in the state.

By Jonathan Nelson

We’re well into the third week of the Texas Legislature and now that the opening ceremonies are out of the way, lawmakers are beginning to get down to business. Both the House and the Senate have released their proposed budgets for the coming biennium, and both have announced committee assignments. Now the real work begins.

This session TAFP aims to fight for the restoration of funding for our family medicine residency programs to help address the increasing shortage of primary care physicians practicing in the state.